Sincalide

Purpose: The assessment of gallbladder function and ejection fraction using sincalide-enhanced biliary scintigraphy is a useful way to evaluate patients with recurrent right upper quadrant pain but no gallstones. Materials and Methods: We wanted to determine whether gallbladder contraction measured by ultrasonography could be used in place of biliary scintigraphy, Biliary scans with an infusion of sincalide and concurrent ultrasonography were performed in 17 patients with histories of recurrent abdominal pain and no evidence of gallstones by ultrasound. Results: Gallbladder ejection fractions calculated by ultrasound and scintigraphy using standard techniques showed only a weak correlation, The poor performance of ultrasound appears to arise because the variable shape of the gallbladder invalidates the calculation of its volume by the formula for a prolate spheroid, When gallbladders that were ellipsoidal were subselected, correlation was improved, The level of training of the sonologist did not have a significant effect on the results. Conclusion: Gallbladder ejection fraction calculated by ultrasonography cannot be used routinely as a substitute for biliary scintigraphy.

Background: Patients with suspected functional biliary pain often undergo cholecystectomy if a decreased gall-bladder ejection fraction (GBEF < 35%) is demonstrated by cholecystokinin cholescintigraphy. However, the validity of GBEF in predicting which patients will have symptomatic relief following cholecystectomy is unclear. Aim: To determine whether patients with suspected functional biliary pain with decreased GBEF have a better symptomatic outcome after cholecystectomy than those with normal GBEF. Methods: Systematic review and meta-analysis of the published literature through MEDLINE and EMBASE databases. Results: We included nine studies with a total of 974 patients with suspected functional biliary pain; 362 patients underwent cholecystectomy. Most studies assessed outcome by direct patient interview. Mean ages across the studies ranged from 35 to 47 years; 78% of all patients were female. Mean duration of follow-up after surgery ranged from 1 to 2.5 years. After cholecystectomy, 94% of the patients with reduced GBEF had a positive outcome compared to 85% among those with normal GBEF. The pooled Mantel-Haenszel odds ratio for positive outcome was 1.37 (95% confidence interval 0.56-3.34), P = 0.56. Conclusion: These data do not support the use of GBEF to select patients with suspected functional biliary pain for cholecystectomy. Prospective randomized trials are required if this practice is to be evidence-based.